title: A third evaluation of tertiary cytoreduction.
abstract: OBJECTIVE
  To evaluate the impact of tertiary cytoreductive surgery (TCS) on patient survival and to determine predictors of optimal TCS.
  
  
  METHODS
  Twenty patients with recurrent epithelial ovarian carcinoma who had TCS at Hacettepe University Hospital during 1992-2004 were retrospectively reviewed.
  
  
  RESULTS
  Tertiary cytoreductive attempt was successful (optimal defined as <2 cm residual) in 12 patients and suboptimal in the remaining eight patients. Seven patients had no macroscopic residual, five patients had <2 cm gross residual and remaining 8 patients had >or=2 cm gross residual disease. Of these alive patients, 10 patients were alive with metastatic disease and only three patients were alive without any evidence of disease. Three patients had operative morbidity (15%), all of which were mild-moderate degree. Multivariate analysis could not differentiate a unique significant factor to have a possible predictor effect of optimal TCS. Multivariate survival analysis also could not differentiate any factor to have significant effect upon patient survival, neither the outcomes of primary, secondary or tertiary cytoreductive surgeries nor the usage of preoperative or postoperative chemotherapies.
  
  
  CONCLUSIONS
  TCS may not be helpful for patient survival. Neither of the clinical factors predicted an optimal TCS. Further larger series are needed for a definite conclusion.
authors.affiliation: Department of Obstetrics and Gynecology, Cankiri Government Hospital, Cankiri, Turkey. mrtgultekin@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Gultekin
authors.forename: Melih
authors.initials: M
authors.lastname: Velipaşaoğlu
authors.forename: Guldeniz
authors.initials: G
authors.lastname: Aksan
authors.forename: Polat
authors.initials: P
authors.lastname: Dursun
authors.forename: Nasuh Utku
authors.initials: NU
authors.lastname: Dogan
authors.forename: Kunter
authors.initials: K
authors.lastname: Yuce
authors.forename: Ali
authors.initials: A
authors.lastname: Ayhan
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies